AXA RoadSafe School Index - assessment form

Thank you for helping us make the areas around schools safer. Please only consider the immediate area of the main school gate/entrance (considered to be 200 yards). Although not absolutely necessary, please undertake the assessment during school drop-off and pick-up times of the day. The 'School Crossing Patrol' only applies if you are assessing during these times - it is not mandatory.

1. Name of school

Name of school

2. Name of road (main gate)

Name of road (main gate)

3. City/town

City/town

4. Type of school e.g. primary (if known)

Type of school e.g. primary (if known)

5. Date of assessment

Date of assessment

6. Time of assessment

Time of assessment

7. What is the speed limit of the road outside the main gate?

What is the speed limit of the road outside the main gate? 20mph

30mph

40mph

50mph

60mph

70mph

8. How many of the following crossings are present?

How many of the following crossings are present? Light Controlled

Zebra

School Crossing Patrol (where possible to identify)

9. Are there speed bumps present?

Are there speed bumps present? Yes

No

10. Are there railings present outside or near the main gate?

Are there railings present outside or near the main gate? Yes

No

11. As far as you can tell, is the main gate used for cars as well as children?

As far as you can tell, is the main gate used for cars as well as children? Yes

No

12. Does the school have a dedicated car park for parents (not teachers)?

Does the school have a dedicated car park for parents (not teachers)? Yes

No

13. Does the school have a dedicated cycle lane?

Does the school have a dedicated cycle lane? Yes

No

14. What is the quality of the pavement like? (1 being outstanding; 4 being inadequate)

What is the quality of the pavement like? (1 being outstanding; 4 being inadequate) 1

2

3

4

15. What is the quality of the 'SCHOOL' and zig-zag road markings like? (1 being outstanding; 4 being inadequate)

What is the quality of the 'SCHOOL' and zig-zag road markings like? (1 being outstanding; 4 being inadequate) 1

2

3

4

16. Is there different coloured tarmac (red/green) present? Please identify colour and location

Is there different coloured tarmac (red/green) present? Please identify colour and location Yes

No

Please specify

17. Notes: Here, please tell us of any obstacles or other road layout issues within 200 yards of the school entrance which could be deemed as dangerous to a child arriving or leaving the school

Notes: Here, please tell us of any obstacles or other road layout issues within 200 yards of the school entrance which could be deemed as dangerous to a child arriving or leaving the school

Once again, many thanks for helping us make the areas around schools even safer for children.